Two weeks after the Inauguration of Donald Trump, Elon Musk tweeted, “We spent the weekend feeding USAID into a wood chipper.” Musk was referring to the Agency for International Development, an agency which supports global health and economic development, and which has saved millions of lives around the world. “A viper’s nest of radical-left lunatics,” Musk called it. U.S.A.I.D.’s funding is authorized by Congress, and its work is a crucial element of American soft power. DOGE has decimated the agency with cuts so sudden and precipitous that federal workers stationed in conflict zones were stranded without safe passage home, as their own government publicly maligned them for alleged fraud and corruption. Courts have blocked aspects of the federal purge of U.S.A.I.D., but it’s not clear if workers can be rehired and contracts restarted, or whether the damage is done. In January, 2022, Atul Gawande, a surgeon and leading public health expert who has written for The New Yorker since 1998, was sworn in as assistant administrator for global health at U.S.A.I.D. He resigned as the new administration came to power, and is watching in shock as Trump and Musk make U.S.A.I.D. a guinea pig for the government-wide purge now under way. U.S.A.I.D. was, he admits, a soft target for MAGA—helping people in faraway countries. Gawande calls U.S.A.I.D. “America at its best.” But with Trump and Musk, “there’s a different world view at play here,” he says. “Power is what matters, not impact.”
Chapter 1: What happened to USAID under Trump and Musk's administration?
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Welcome to the New Yorker Radio Hour. I'm David Remnick. Two weeks after the inauguration of Donald Trump, the new president's chief campaign funder, his consigliere, and the richest man in the world, Elon Musk, tweeted in a tone of glee, Musk was, of course, referring to the Agency for International Development, an agency that has saved millions of lives.
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Chapter 2: How did Atul Gawande contribute to global health at USAID?
If the power of the United States means something positive around the world, the efforts of thousands of foreign aid workers in USAID, doctors, nurses, logistics experts of all kinds, have a lot to do with that. But Musk and Trump see it otherwise, and they have decimated the agency. Into the wood chipper it has gone. Now the courts have blocked aspects of the federal purge of USAID.
But the damage can't easily be undone. Atul Gawande was a senior leader of USAID during the Biden administration. He ran critical health programs all over the world. Gawande is a surgeon, an author, and my longtime colleague writing for The New Yorker. He's been watching in absolute horror as the agency has been summarily pulped. We spoke last week.
Atul, President Biden appointed you as the assistant administrator for global health at USAID, and you stepped down on Trump's inauguration day. And he immediately began targeting USAID with an executive order that halted all foreign aid. Did you know or did you intuit that Trump would act the way he has?
No idea. previous Trump administration, they had embraced what they themselves called the normals. They had a head of USAID who was devoted to the idea of development and soft power in the world. Now, they had their own wrinkle on it. which I didn't disagree with. They called it the journey to self-reliance.
They wanted to invest in Africa, in Asia, in Latin America to enable stronger economies, more capacity. And we weren't doing enough of that. And I actually continued much of the work that had occurred during that time.
Well, tell me a little bit about what you were in charge of, what the good that was being done in the world was.
Yeah, so this is a job where I had 2,500 people between DC and 65 countries around the world working on advancing health and protecting Americans from diseases and outbreaks abroad.
And the aim was to work with country to build their systems so that we protected the global health security and improved global outcomes of everything from reducing HIV, AIDS, and other infectious diseases like malaria and TB to strengthening primary healthcare systems so those countries would move on from depending on aid from donors.
That work, in three years, we documented being able to save more than 1.2 million lives after COVID alone.
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Chapter 3: What are the consequences of cutting USAID funding?
So I'll say there are broadly three areas. The biggest part of USAID is it's the FEMA for disasters abroad. It's called Bureau of Humanitarian Assistance. And they bring earthquake response, wildfire response in conflicts, you know, famines. These are the people who suit up and get assistance and stabilize places where things are going wrong. You know, John F. Kennedy, when he
formed USAID in 1961, said it was to counter the adversaries of freedom and to provide compassionate support for the development of the world. And those components are the ones where it's USAID has kept Ukraine's not only health system going, made important, vital support to keep their energy infrastructure going as Russia attacked it, right?
In Haiti, this is the response team that has sought to stabilize what's become a gang-controlled country. major part of the country. And our health teams kept almost half of the primary health care system for the population going. So around the world, stopping fentanyl flow, all of that has been wiped out completely.
And in many cases, the people behind that work, I mean, many of the people were working with local partners to keep these things going. Those partners are being attacked in country after country.
What you're describing, beyond simple human compassion, is soft power. Describe what that is, why is it so important to the United States and to the world, and what will squandering it, what will destroying it mean?
The tools of foreign policy, as I've learned, are defense, diplomacy, and development. And the development part is the soft power part. We're not sending troops into Asia and into Africa and into Latin America. We're sending hundreds of thousands of civilians without uniforms who are there to
to represent the United States, to pursue common goals together, whether it's stemming the tide of fentanyl coming across the border, addressing climate disasters, protecting the world from disease.
And that soft power is a reflection of our values, what we stand for, our strong belief in freedom, self-determination, and advancement of people's economies, bringing more stability and peace to the world.
That is the fundamental nature of soft power, that we're not what Trump is currently trying to create, a world of simply might makes right and you do what we tell you, because that does not create stability. It creates chaos and destruction.
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Chapter 4: What is soft power and why is it important?
None of these people went in for the money. It's not like they had any power.
I assume all of them could have made more money elsewhere.
Absolutely. And, you know, many of them spent their lives as foreign service officers living in difficult places in the world. And, you know, I remember Kiev was under attack about eight weeks after I was sworn in. And I thought I was going to be working on COVID. But here is this thing erupting.
First of all, our health team, along with the rest of the mission and embassy in Kyiv, had to flee for safety. But within a week, they already were like, we have TB breaking out. We have potential polio case. How are we going to respond? And my critical role is to say... What's going to kill people the most?
Right now, Russia has shut down the medical supply chain, and so 100% of the pharmacies just closed. 250,000 HIV patients can't get their meds. A million heart patients can't get their meds. Let's get the pharmacies open. And by the way, they've attacked the oxygen factories and put the hospitals under cyber attack, and their electronic systems aren't functioning.
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Chapter 5: How does the current administration view foreign aid?
And this team in four weeks were able to move the entire hospital record system to the cloud, allowing protection against cyber attacks, got oxygen systems back online, and were able to get 50% of the pharmacies open in about a month. And it ultimately got 80% of the pharmacies open. That is just incredible. Like, yes, I mean, are there some people I had to deal with who were overly bureaucratic.
Did I have to address some people who were not performing? Absolutely. And did I have to drive efficiency? And in every place you have to do that. But this was America at its best. And I was so proud to be part of that. And what frustrated me was in that job, I had to speak for the US government. I couldn't write for you during that time. Believe me, I know. I couldn't tell the story.
I've got a book I'm working on now that I... hope to be able to unpack all of this. But it is, I think, a sad part of not getting to be part of my leadership that I didn't also get to communicate what we do, partly because USAID is restricted in certain ways from telling its story within the U.S. borders.
Atul, if you could tell Elon Musk and Donald Trump directly what you're telling me about lives saved, good works done, the benefits of soft power to the United States and to the world, and so on, do you think it would have any effect on them at all?
Zero. There's a different worldview at play here. It is that power is what matters. Not impact, not the overall maximum good that you can do. And having power, wielding it in ways that can dominate the weak and partner with your friends. When I say partner with friends, I mean partner with people like Putin who think the same way that you do.
Well, a final question then. Is it irreparable? Is this damage done and done forever?
This damage has created effects that will be forever. It will not come back. Like, let's say they turned everything back on again and said, oops, I'm sorry.
Yeah.
I had a discussion with a minister of health just today, and he said, I've never been treated so much like a second-class human being.
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Chapter 6: What are the immediate effects of USAID's budget cuts?
Yes, this is a minister of health in another country, let me just say. And for decades, America was there.
I never imagined America could be indifferent, could simply abandon people in the midst of treatments, in the midst of trials, clinical trials, in the midst of partnership, and not even talk to me, not even have a discussion so that we could plan together, okay, you're going to have big cuts to make. We will work together and figure out how to solve it. That's not what happened.
And never will trust the U.S. again. And we are entering a different state of relations. You know, in some ways, I think there will be, we are seeing lots of other countries stand up around the world. Our friends, Canada, Mexico, but, you know, African countries too, Europe. Everybody's taking the lesson that America cannot be trusted.
It's tragic and outrageous, no?
That is beautifully put. What I say, I'm a little stronger. It's shameful and evil.
Atul Gawande, thank you. Thank you. Atul Gawande was assistant administrator of the U.S. Agency for International Development until January. He's a surgeon, a professor of health policy, and a longtime contributor to The New Yorker. This is the New Yorker Radio Hour. I'm David Remnick. Thanks for listening. See you next time.
The New Yorker Radio Hour is a co-production of WNYC Studios and The New Yorker. Our theme music was composed and performed by Meryl Garbus of Tune Yards, with additional music by Louis Mitchell. This episode was produced by Max Balton, Adam Howard, David Krasnow, Jeffrey Masters, Louis Mitchell, Jared Paul, and Ursula Sommer.
With guidance from Emily Botin and assistance from Michael May, David Gable, Alex Barish, Victor Guan, and Alejandra Deckett. The New Yorker Radio Hour is supported in part by the Cherena Endowment Fund.
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Chapter 7: What challenges do USAID workers face on the ground?
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